Supportive Care in Cancer

, Volume 17, Issue 8, pp 1101–1107 | Cite as

Non-disclosure of cancer diagnosis: an examination of personal, medical, and psychosocial factors

  • Csaba L. Dégi
Original Article



In recent psycho-oncological literature, few studies are concerned with the consequences of cancer diagnosis non-disclosure. The aims of this study were to analyze factors that may explain the non-disclosure of cancer diagnosis to patients by physicians and to compare personal characteristics of cancer patients, on the basis of cancer diagnosis disclosure versus non-disclosure.


A total of 420 hospitalized cancer patients were included in our study; 342 with malignant and 78 with benign tumors. Two hundred thirty-eight women and 185 men completed a self-report questionnaire that included standardized measures of depressive symptoms (BDI), hopelessness, ways of coping, negative life events and anomie. Data were controlled for demographic, medical, and psychosocial factors.


Malignant cancer (OR:11.88), severe and moderate depression (OR:10.57 and OR:4.81), lack of chemotherapy (OR:4.20) and low anomie (OR:2.77) after overall adjustment predicted cancer diagnosis non-disclosure to patients.


Our results underline the persistent need for delivering patient-focused health services in oncological care based on respect for the patients’ right to autonomy.


Cancer diagnosis Non-disclosure Depression Patient-focused care 



The author would like to express his greatest gratitude to Professor Ellen Csikai PhD for her assistance in editing this manuscript and for her useful comments on the manuscript.


  1. 1.
    Butow PN, Kazemi JN, Beeney LJ, Griffin A, Dunn SM, Tattersall MHN (1996) When the diagnosis is cancer: patient communication experiences and preferences. Cancer 77(12):2630–2637 doi: 10.1002/(SICI)1097-0142(19960615)77:12<2630::AID-CNCR29>3.0.CO;2-S PubMedCrossRefGoogle Scholar
  2. 2.
    Bailey RK, Geyen DJ, Scott-Gurnell K, Hipolito MMS, Bailey TA, Beal JM (2005) Understanding and treating depression among cancer patients. Int J Gynecol Cancer 15:203–208 doi: 10.1111/j.1525-1438.2005.15204.x PubMedCrossRefGoogle Scholar
  3. 3.
    Massie MJ (2004) Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 32:57–71 doi: 10.1093/jncimonographs/lgh014 PubMedCrossRefGoogle Scholar
  4. 4.
    Folkman S, Lazarus R (1980) An analysis of coping in a middle aged community sample. J Health Soc Behav 21:219–239 doi: 10.2307/2136617 PubMedCrossRefGoogle Scholar
  5. 5.
    Kopp M (2006a) A pszichoszociális tényezők jelentősége, különös tekintettel a megelőzésre. In: Onkopszichológia a gyakorlatban. Medicina, Budapest, pp 42–50Google Scholar
  6. 6.
    Riskó Á (2006) A daganatos betegség különböző fázisaiban az alkalmazkodás pszichoszociális jellemzői. In: Onkopszichológia a gyakorlatban. Medicina, Budapest, pp 85–92Google Scholar
  7. 7.
    Siminoff LA, Ravdin P, Colabianchi N, Sauders-Sturm CM (2000) Doctor–patient communication patterns in breast cancer adjuvant therapy discussions. Health Expect 3:26–36 doi: 10.1046/j.1369-6513.2000.00074.x PubMedCrossRefGoogle Scholar
  8. 8.
    Lin CC (1999) Disclosure of the cancer diagnosis as it relates to the quality of pain management among patients with cancer pain in Taiwan. J Pain Symptom Manage 18(5):331–337 doi: 10.1016/S0885-3924(99)00091-3 PubMedCrossRefGoogle Scholar
  9. 9.
    Roberts CS, Cox CE, Reintgen DS, Baile WF, Gibertini M (1994) Influence of physician communication on newly diagnosed breast patients’ psychologic adjustment and decision-making. Cancer 74:336–341PubMedCrossRefGoogle Scholar
  10. 10.
    Roter D (1989) Which facets of communication have strong effects on outcome—a meta-analysis. In: Communicating with medical patients. Sage, Newbury Park, pp 183–196Google Scholar
  11. 11.
    Sardell AN, Trierweiler SJ (1993) Disclosing the cancer diagnosis. Cancer 72:3355–3365 doi: 10.1002/1097-0142(19931201)72:11<3355::AID-CNCR2820721135>3.0.CO;2-D PubMedCrossRefGoogle Scholar
  12. 12.
    Fallowfield LJ, Baum M, Maguire GP (1986) Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancer. Br Med Bull 293:1331–1334Google Scholar
  13. 13.
    Holland JC, Geary N, Marchini A, Tross S (1987) An international survey of physician attitudes and practice in regard to revealing the diagnosis of cancer. Cancer Invest 5:151–154 doi: 10.3109/07357908709018468 PubMedCrossRefGoogle Scholar
  14. 14.
    Mystakidou K, Parpa E, Tsilika E, Katsouda E, Vlahos L (2004) Cancer information disclosure in different cultural contexts. Support Care Cancer 12:147–154 doi: 10.1007/s00520-003-0552-7 PubMedCrossRefGoogle Scholar
  15. 15.
    Faria SL, Souhami L (1997) Communication with the cancer patient: information and truth in Brazil. Ann N Y Acad Sci 809:163–171 doi: 10.1111/j.1749-6632.1997.tb48079.x PubMedCrossRefGoogle Scholar
  16. 16.
    Torrecillas L (1997) Communication of the cancer diagnosis to Mexican patients. Ann N Y Acad Sci 809:188–196 doi: 10.1111/j.1749-6632.1997.tb48082.x PubMedCrossRefGoogle Scholar
  17. 17.
    Hospice Romania (2008) Campanie nationala de constientizare a problemelor cu care se confrunta pacientii cu boli grave in stadii avansate—Planul de servicii paliative. Cited 24 February 2008
  18. 18.
    Esbensen BA, Swane CE, Hallberg IR, Thome B (2008) Being given a cancer diagnosis in old age: a phenomenological study. Int J Nurs Stud 45(3):393–405 doi: 10.1016/j.ijnurstu.2006.09.004 PubMedCrossRefGoogle Scholar
  19. 19.
    Maynard DW (2006) “Does it mean I’m gonna die?” On meaning assessment in the delivery of diagnostic news. Soc Sci Med 62(8):1902–1916 doi: 10.1016/j.socscimed.2005.09.011 PubMedCrossRefGoogle Scholar
  20. 20.
    Baile WF, Lenzi R, Kudelka AP, Maguire P, Novack D, Goldstein M, Myers EG, Bust RC Jr (1997) Improving physician–patient communication in cancer care: outcome of a workshop for oncologists. J Cancer Educ 12:166–173PubMedGoogle Scholar
  21. 21.
    Fallowfield L, Jenkins V (1999) Effective communication skills are the key to good cancer care. Eur J Cancer 35:1592–1597 doi: 10.1016/S0959-8049(99)00212-9 PubMedCrossRefGoogle Scholar
  22. 22.
    Horikawa N, Yamazaki T, Sagawa M, Nagata T (2000) Changes in disclosure of information to cancer patients in a general hospital in Japan. Gen Hosp Psychiatry 22:37–42 doi: 10.1016/S0163-8343(99)00042-0 PubMedCrossRefGoogle Scholar
  23. 23.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571PubMedGoogle Scholar
  24. 24.
    Kopp M, Falger P, Appels A, Szedmák S (1998) Depression and vital exhaustion are differentially related to behavioural risk factors for coronary heart disease. Psychosom Med 60:752–758PubMedGoogle Scholar
  25. 25.
    Kopp MS, Skrabski Á, Szedmák S (2000) Psychosocial risk factors, inequality and self-rated morbidity in a changing society. Soc Sci Med 51:1350–1361 doi: 10.1016/S0277-9536(00)00097-6 CrossRefGoogle Scholar
  26. 26.
    Beck AT, Weissman A, Lester D, Trexler L (1974) The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol 42:861–865 doi: 10.1037/h0037562 PubMedCrossRefGoogle Scholar
  27. 27.
    Perczel-Forintos D, Sallai J, Rózsa S (2001) A Beck-féle Reménytelenség Skála pszichometriai vizsgálata. Psychiatr Hung 16(6):632–643Google Scholar
  28. 28.
    Kopp M, Skrabski Á (1992) Magyar lelkiállapot. Végeken Alapítvány, BudapestGoogle Scholar
  29. 29.
    Rahe RH, Tolles RL (2002) The brief stress and coping inventory: a useful stress management Instrument. Int J Stress Manag 9:61–70 doi: 10.1023/A:1014950618756 CrossRefGoogle Scholar
  30. 30.
    Kopp M, Skrabski Á, Szedmák S (1999) A testi és lelki egészség összefüggései országos reprezentatív felmérések alapján. Demografia 17(1–2):88–119Google Scholar
  31. 31.
    Cox A, Jenkins V, Catt S, Langridge C, Fallowfield L (2006) Information needs and experiences: an audit of UK cancer patients. Eur J Oncol Nurs 10(4):263–272 doi: 10.1016/j.ejon.2005.10.007 PubMedCrossRefGoogle Scholar
  32. 32.
    Pronzato P, Bertelli G, Losardo P, Landucci M (1994) What do advanced cancer patients know of their disease? A report from Italy. Support Care Cancer 2(4):242–244 doi: 10.1007/BF00365729 PubMedCrossRefGoogle Scholar
  33. 33.
    Annunziata MA (1997) Ethics of relationship. From communication to conversation. Ann N Y Acad Sci 809:400–410 doi: 10.1111/j.1749-6632.1997.tb48103.x PubMedCrossRefGoogle Scholar
  34. 34.
    Mystakidou K, Parpa E, Tsilika E, Kalaidopoulou O, Vlahos L (2002) The families’ evaluation on management, care and disclosure for terminal stage cancer patients. BMC Palliat Care 1:3 doi: 10.1186/1472-684X-1-3 PubMedCrossRefGoogle Scholar
  35. 35.
    Gotay CG (1996) Cultural variation in family adjustment to cancer. In: Cancer and the family. Wiley, New York, pp 31–49Google Scholar
  36. 36.
    Phungrassami T, Sriplung H, Roka A, Mintrasak E, Peerawong T, Aegem U (2003) Disclosure of a cancer diagnosis in Thai patients treated with radiotherapy. Soc Sci Med 57(9):1675–1682 doi: 10.1016/S0277-9536(02)00552-X PubMedCrossRefGoogle Scholar
  37. 37.
    Wang SY, Chen CH, Chen YS, Huang HL (2004) The attitude toward truth telling of cancer in Taiwan. J Psychosom Res 57(1):53–58 doi: 10.1016/S0022-3999(03)00566-X PubMedCrossRefGoogle Scholar
  38. 38.
    Horikawa N, Yamazaki T, Sagawa M, Nagata T (1999) The disclosure of information to cancer patients and its relationship to their mental state in a consultation–liaison psychiatry setting in Japan. Gen Hosp Psychiatry 21:368–373 doi: 10.1016/S0163-8343(99)00026-2 PubMedCrossRefGoogle Scholar
  39. 39.
    Mallinger J, Griggs J, Shields C (2005) Patient-centered care and breast cancer survivors’ satisfaction with information. Patient Educ Couns 57:342–349 doi: 10.1016/j.pec.2004.09.009 PubMedCrossRefGoogle Scholar
  40. 40.
    Davidson JR, Brundage MD, Feldman-Stewart D (1999) Lung cancer treatment decisions: patients’ desires for participation and information. Psychooncology 8:511–520 doi: 10.1002/(SICI)1099-1611(199911/12)8:6<511::AID-PON415>3.0.CO;2-T PubMedCrossRefGoogle Scholar
  41. 41.
    Grassi L, Indelli M, Marzola M, Maestri A, Santini A, Piva E, Boccalon M (1996) Depression and quality of life in home care assisted cancer patients. J Pain Symptom Manage 12:300–307 doi: 10.1016/S0885-3924(96)00181-9 PubMedCrossRefGoogle Scholar
  42. 42.
    Henriksson MM, Isometsa ET, Hietanen PS, Aro HM, Lonnqvist JK (1995) Mental disorders in cancer suicides. J Affect Disord 36:11–20 doi: 10.1016/0165-0327(95)00047-X PubMedCrossRefGoogle Scholar
  43. 43.
    Pirl WF, Roth AJ (1999) Diagnosis and treatment of depression in cancer patients. Oncology 13:1293–1302 1305–1306PubMedGoogle Scholar
  44. 44.
    Gidron Y, Russ K, Tissarchondou H, Warner J (2006) The relation between psychological factors and DNA-damage: a critical review. Biol Psychol 72:291–304 doi: 10.1016/j.biopsycho.2005.11.011 PubMedCrossRefGoogle Scholar
  45. 45.
    Irie M, Miyata M, Kasai H (2005) Depression and possible cancer risk due to oxidative DNA damage. J Psychiatr Res 39:553–560 doi: 10.1016/j.jpsychires.2005.01.009 PubMedCrossRefGoogle Scholar
  46. 46.
    Kopp M, Skrabski A, Szanto Z, Siegrist J (2006b) Psychosocial determinants of premature cardiovascular mortality differences within Hungary. J Epidemiol Community Health 60(9):782–788 doi: 10.1136/jech.2005.042960 PubMedCrossRefGoogle Scholar
  47. 47.
    Persson L, Hallberg IR (2004) Lived experience of survivors of leukemia or malignant lymphoma. Cancer Nurs 27:303–313 doi: 10.1097/00002820-200407000-00007 PubMedCrossRefGoogle Scholar
  48. 48.
    Tiedje L, Holzman CB, De Vos E, Jia X, Korzeniewski S, Rahbar MH, Goble MM, Kallen D (2008) Hostility and anomie: links to preterm delivery subtypes and ambulatory blood pressure at mid-pregnancy. Soc Sci Med 66:1310–1321PubMedGoogle Scholar
  49. 49.
    Skrabski A, Kopp M, Kawachi I (2003) Social capital in a changing society: cross-sectional associations with middle-aged female and male mortality rates. J Epidemiol Community Health 57(2):114–119 doi: 10.1136/jech.57.2.114 PubMedCrossRefGoogle Scholar
  50. 50.
    Kvale K (2007) Do cancer patients always want to talk about difficult emotions? A qualitative study of cancer inpatients communication needs. Eur J Oncol Nurs 11(4):320–327 doi: 10.1016/j.ejon.2007.01.002 PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Institute of Behavioral SciencesSemmelweis UniversityBudapestHungary

Personalised recommendations